LD 415
pg. 1
LD 415 Title Page An Act to Strengthen Health Maintenance Organization Insolvency Requirements ... LD 415 Title Page
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LR 2083
Item 1

 
Be it enacted by the People of the State of Maine as follows:

 
Sec. 1. 24-A MRSA §4203, sub-§3, ¶R, as enacted by PL 1989, c. 842, §7,
is amended to read:

 
R. A description of procedures to be implemented to meet
the protection against insolvency requirements in section
4204, subsection 2-A, paragraph D and section 4204-A; and

 
Sec. 2. 24-A MRSA §4203, sub-§3, ¶S, as amended by PL 1997, c. 370, Pt.
F, §1, is further amended to read:

 
S. A list of the names and addresses of all physicians and
facilities with which the health maintenance organization
has or will have agreements. If products are offered that
pay full benefits only when providers within a subset of the
contracted physicians or facilities are utilized, a list of
the providers in that limited network must be included, as
well as a list of the geographic areas where the products
are offered.; and

 
Sec. 3. 24-A MRSA §4203, sub-§3, ¶T is enacted to read:

 
T.__Proof of insurance adequate to ensure payment for at
least 120 days worth of managed care claims payments owed to
participating providers in the event of insolvency.

 
SUMMARY

 
This bill requires that health maintenance organizations carry
insurance adequate to ensure payment for at least 120 days worth
of managed care claims payments owed to participating providers
in the event of insolvency.


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